Gidget74: “I am crying a lot for no reason.  I just think of it as another way for my body to purge the nicotine.”

divinem: “I shed an ocean of tears during my first year.  Let them wash away the pain deep inside.  Quitting takes us to new heights – and depths”

lynnTheSurvivor:  “Thank you ALL so much J!  Feeling better today J”

kickthehabit101: “Glad you are better…one thing about getting so far down…the only way to go st up!”

lynnTheSurvivor:  “I think the world of you!  Thanks hunny!”

That conversation may look like a run-of-the-mill online chat to you, but to Professor Damon Centola, a researcher at MIT’s Sloan School of Management, it is a new kind of laboratory — and an example of a potential goldmine of information on how to help people live healthier lives.

“Online health environments may provide a brand new opportunity for research on the social determinants of health,” he  said.

Centola published a paper in the American Heart Association’s journal Circulation  last month on how Facebook, Twitter and specialized social networks like QuitNet form a new frontier for researching health behavior. He analyzed the results of several studies examining the link between online influence and health behaviors, which suggest successes in behaviors like smoking cessation, exercise and medication compliance can be shaped by interactions over web-based social platforms.

It’s no shocker that social networks can influence behavior — everything from succeeding at Weight Watchers, for instance, to actually getting a mammogram after years of delays and canceled appointments.  What Centola is fired up about is the idea that online social forums are treasure troves for gleaning real-time behavioral data, the gold nuggets needed for realizing the gold standard approach to scientific research, the randomized control trial. “Large scale public health theories typically cannot be tested experimentally,” he says.

To do that, researchers would have to compare the outcomes of social interventions on entire populations; a daunting task.

Randomized control trials have traditionally been almost exclusively the domain of physical scientists.  Social scientists studying behavior, like Centola, have been stuck with the murkier method of the observational study.  Though they produce important associative pictures, like how television habits of 20 plus hours a week are linked to significantly shriveled sperm counts,  observational studies can leave causal considerations shrouded in mystery.

Ambiguous results often mean unclear policy recommendations coming from behavioral scientists, but  Centola says that his method could change all of that He says the potential to use social media for the basis of such experiments is vast because, “hundreds of thousands, or in some cases, millions of people are participating in these online communities, making these sites active domains of public health.”

Is the idea that what happens on Facebook stays on Facebook really the case these days?  Centola suggests that some researchers consider the digital universe to be an entirely separate space from the “real world” where you actually have to interact with people face to face. “Online and offline behaviors are two different worlds of research right now,” he says. “The suggestion [in this study] is that these are all interacting problems.”

Centola argues that these online networks are not mere proxies of what happens in real-life, but they are actually interactive spaces embedded in the real-life, modern experience. “My goal is to connect these online health interactions with real offline health outcomes, such as changes in medication, blood pressure, and obesity,” he says.

But what about my grandma who has never even touched a computer, never mind tweeting about, say, osteoporosis prevention? There remain vast segments of the population who don’t access online interactive spaces.  Centola appreciates the problem of the “Digital Divide.”

“With the excitement over the Internet and a number of sources of big data, even in observational data, the representativeness of the population can get lost,” he says.

Centola explains that his online methods for data collection do not eclipse the standard practices of social science research.  Rather, he says, his methods should be considered complimentary to other modes of data-gathering.

So what does the future hold for using online networks to analyze health behavior?  Centola thinks his method holds a lot of promise for the future of public health intervention design, but the implications are only now beginning to be explored. “[The study is] meant to be thought provoking in terms of what the potential is in doing massive, significant research online on changes in health behavior.”

And, it’s expensive.

The Centers for Disease Control and Prevention says smoking costs the country $193 billion a year in lost productivity and health care spending. Add another $10 billion for secondhand smoking expenses.

The federal Affordable Care Act says insurers can charge smokers up to 50 percent more for coverage than non-smokers.

So, says Jon Hurst, president of the Retailers Association of Massachusetts, why not ask smokers to pay more for health insurance?

“If we’re ever going to control costs, we’ve got to make sure that we don’t over-socialize the system,” Hurst says. “In other words, we don’t make people pay too much for somebody else’s health care costs.”

Fifty percent more for smokers might be too much, continues Hurst, “but let’s not dismiss outright, the ability for employers to try to incent people to get healthier.”

The debate about whether to make smokers pay more for health insurance has created some unusual alliances. Tobacco companies are working alongside cancer societies and consumer groups to persuade states they should reject higher charges for smokers.

“First of all there is very little evidence that financial incentives or disincentives through premiums change behavior,” says Amy Whitcomb Slemmer, executive director at Health Care for All.

Her group and others in the public health world routinely support higher taxes for smokers. But Whitcomb Slemmer says she’s worried that higher insurance premiums will lead many smokers to drop their coverage.

“We were concerned that more would pay the penalty to not be insured,” Whitcomb Slemmer continues. “And, specifically, we’d be concerned that they (smokers) wouldn’t have access to what has been demonstrated to be very effective smoking cessation programming.”

In Massachusetts, Vermont, Rhode Island and the District of Columbia, this public health perspective has won the debate — for now. Insurers will not be allowed to add a surcharge for smokers. The Patrick administration says it’s open to considering this action in the future — if insurers come up with more accurate ways to determine who smokes and who doesn’t.

But there’s a twist. Insurers in Massachusetts have been able to hike premiums for smokers since the state passed its landmark health care law in 2006 (the one used as a model for the federal law). But almost no one is doing that.

“The idea here is that we try to moderate premiums for the entire market, not seek to target particular populations or individuals because of certain behaviors,” says Eric Linzer, senior vice president at the Massachusetts Association of Health Plans.

The ban on higher charges for smokers will apply to about half of Massachusetts residents who have insurance through their employer. Large employers, who follow federal insurance rules, will be able to target smokers, if they choose.

According to a new national health statistics report out today analyzing five key health behaviors among U.S. adults — sufficient sleep, smoking, drinking, obesity, and physical activity — there are several bright spots. For instance, the survey found that fewer young people (18-24) are smoking and the number of adults who report they’re completely aerobically inactive showed ‘notable’ declines in recent years, from 39.7% inactive between 2005-2007 to 33.9% in the years 2008-2010.

O.K., now the bad news: Heavy drinking has increased, except among the senior set over 75, smoking prevalence remains virtually unchanged (beyond the youngsters) and obesity is up.

My first reaction is: Huh? Is anyone out there listening to Michelle Obama and all those other Get-Out-There-And-Move and Cut-The-Sugar advocates?

But then I talked to Dr. Eddie Phillips, director of the Institute of Lifestyle Medicine and an assistant professor of Physical Medicine and Rehabilitation at Harvard Medical School, who insisted on highlighting the positive.

A little background: Dr. Phillips’ focus is on physical activity, the link between health and exercise and on educating physicians about how to more seamlessly incorporate physical activity into the practice of medicine.

His takeaway from the CDC report is this: “People are starting to move.”

What’s truly promising, he says, is that the ‘notable decline’ in aerobically inactive adults comes on the heels of a global campaign to have doctors assess physical activity as a vital sign and then “prescribe” exercise as they would any other medication. This suggests that both practitioners and patients are starting to get the message.

Dr. Phillips adds that his overall gestalt on the topic is that “this is not an all or nothing” prospect: “It’s not like you’re ‘healthy’ or you’re ‘not healthy.’ “If you make small changes, it makes an impact.”

So, for instance, he says, even if you don’t meet the federal guidelines for physical activity — 150 minutes per week of moderate-intensity physical activity, like brisk walking — it still helps to do something. “Seventy-five minutes is OK,” Phillips says. “Anything you do short of sitting on the couch is beneficial.”

Dr. Phillips even has something upbeat to say on the CDC finding that obesity is up, noting that, while he’s not an obesity expert, studies have found that being physically active is somewhat protective against the medical conditions associated with obesity. “So if we have a lot of heavy people walking briskly, we may be ahead of the game,” he says.

On an individual level, Dr. Phillips adds: “The challenge is not about getting the information out: people know they’re supposed to be moving and eating less junk food. This is a translational issue; it’s about encouraging them to make modest, sustainable changes.” On the overall statistics, he says: “This is a report card, so while there are some bad marks, there are also places where, as students, there’s hope.”

Here are more of the bottom line numbers, from the CDC report:

•About 6 in 10 (64.9%) U.S. adults were current drinkers in 2008–2010; about 1 in 5 adults (20.9%) were lifetime abstainers.

•About one in five adults (20.2%) were current smokers and over one-half of adults (58.6%) had never smoked cigarettes. Less than one-half of current smokers (45.8%) attempted to quit smoking in the past year.

•Nearly one-half (46.1%) of adults met the federal guidelines for aerobic physical activity, about one-quarter (23.0%) of adults met the federal guidelines for muscle strengthening physical activity, and about one in five adults (19.4%) met both guidelines.

•About 6 in 10 adults (62.1%) were overweight or obese (BMI ≥ 25), with about 4 in 10 (36.1%) adults being of healthy weight (18.5 ≤ BMI < 25).

•About 7 in 10 adults (69.7%) met the Healthy People 2020 objective for sufficient sleep.

The report is massive and you could spend the day wading through it, comparing men and women, racial groups and income levels. (For instance: “Adults who had family incomes four times the poverty level or more (57.8%) were nearly twice as likely as adults with family incomes below the poverty level (32.4%) to have met the 2008 guidelines for aerobic physical activity through leisure­ time activity.”)

Here are some notable changes since the government last conducted the survey:

•Since the last report, the percentage of adults who had five or more drinks in 1 day at least once in the past year increased from 20.5% (2005–2007) to 23.6% (2008–2010)— with increases in every age group except adults aged 75 and over.

•Adult smoking prevalence remained unchanged between 2005–2007 (20.4%) and 2008–2010 (20.2%) although declines were seen among adults in the youngest age group (aged 18–24) from 23.5% (2005–2007) to 21.2% (2008–2010)

•With the introduction of new national physical activity objectives since the last report, direct comparisons of the percentage of adults meeting most physical activity goals are not possible; however, the goal of reducing the percentage of adults who are physically inactive in terms of aerobic activity remains comparable. The percentage of adults who were completely aerobically inactive had remained at 38%–40% between 1997 and 2004. However, in subsequent years the percentage of adults who were aerobically inactive showed a notable decline from 39.7% (2005–2007) to 33.9% (2008–2010). This decline coincides with the release of the 2008 federal guidelines for physical activity and major public health initiatives to promote physical activity.

•Yet despite declines in physical inactivity, the percentage of adults who were obese increased from 25.4% to 27.4% during this time period; the percentage of adults who were overweight but not obese, on the other hand, remained stable at about 35%.

•For ages 25 and over, the percentage of adults who got insufficient sleep remained essentially unchanged between 2005–2007 and 2008–2010.

So what happened?

Kevin Outterson, a professor at the Boston University School of Law and co-director of the Health Law Program, reports today that additional money that was supposed to be used to inspect compounding pharmacies around the state was cut to zero. At least for now.

Blogging for The Incidental Economist, he reminds us why the inspections are important: “fungal meningitis from improperly compounded products killed 55 people and infected more that 600.” But apparently, in the latest state budget proposal, money for inspections has been cut, Outterson writes:

All of these products originated in Massachusetts, but all of the injuries occurred in other states. But Massachusetts felt some responsibility for the failures at NECC, as acknowledged by both Gov. Patrick and the Interim Commissioner of Public Health. The DPH enacted emergency regulations on Nov. 1, 2012 and the Governor’s special commission delivered a comprehensive set of recommendations. Both efforts informed the Governor’s proposed legislation in January 2013 and several bills pending in the Massachusetts House and Senate.

In the interim, the Governor boosted the budget for inspections at compounding pharmacies. In a series of surprise inspections, just 4 out of 37 compounding pharmacies passed. The Governor proposed an additional $1 million for pharmacy inspections next year.

So it comes as a surprise that the Governor’s requested budget was cut to zero by the Massachusetts Senate Ways & Means FY 2014 proposed budget (4510-0772). Sen. Keenan has filed an amendment to restore about $600,000 for additional compounding pharmacy inspections (proposed amendment 513), but it is not clear whether that amendment will pass or whether that amount is sufficient. Action by the US Congress may take some time, so it is up to the states to police compounding pharmacies until we get federal legislation.

In the inimitably dry language of the nation’s public health authorities: “A study of public pools done during last summer’s swim season found that feces are frequently introduced into pool water by swimmers.”

Moreover, the study found:

“Fifty-eight percent of the pool filter samples tested were positive for E. coli, bacteria normally found in the human gut and feces. The E. coli is a marker for fecal contamination. Finding a high percentage of E. coli-positive filters indicates swimmers frequently contaminate pool water when they have a fecal incident in the water or when feces rinse off of their bodies because they do not shower thoroughly before getting into the water.”

(Be honest, does anyone really shower before getting into the pool? Maybe it’s time to start.)

So, what’s a swimmer to do?

The CDC offers these tips:

–Keep feces and other contaminants out of the water.
–Do not swim when you have diarrhea.
–Shower with soap before you start swimming.
–Take a rinse shower before you get back into the water.
–Take bathroom breaks every 60 minutes.
–Wash your hands with soap after using the toilet or changing diapers.
–Check the chlorine level and pH before getting into the water.

Here’s my desperate attempt at a silver lining: Germs are on the upswing (see, for instance, foodie Michael Pollan’s take in this Sunday’s New York Times) and a ton of new research finds that bacteria of all sorts can boost your immune system, and so fecal contamination may be just what the doctor ordered, right?

Here’s more from the CDC news release:

Through the study, released today by the Centers for Disease Control and Prevention (CDC), researchers found germs in samples of pool filter water collected from public pools.
CDC collected samples of water from pool filters from public pools and tested the samples for genetic material (for example, DNA) of multiple microbes. The study found that 58 percent of the pool filter samples tested were positive for E. coli, bacteria normally found in the human gut and feces… No samples tested positive for E. coli O157:H7, a toxin-producing E. coli strain that causes illness.

Pseudomonas aeruginosa, which can cause skin rashes and ear infections, was detected in 59 percent of samples. Finding Pseudomonas aeruginosa in the water indicates natural environmental contamination or contamination introduced by swimmers. Cryptosporidium and Giardia, germs that are spread through feces and cause diarrhea, were found in less than 2 percent of samples.

The tests used in the study do not indicate whether the detected germs were alive or able to cause infections. Indoor and outdoor public pools were sampled.

The study did not address water parks, residential pools or other types of recreational water. The study does not allow CDC to make conclusions about all pools in the United States. However, it is unlikely that swimmer-introduced contamination, or swimmer hygiene practices, differ between pools in the study and those in the rest of the country.

“Swimming is an excellent way to get the physical activity needed to stay healthy,” said Michele Hlavsa, chief of CDC’s Healthy Swimming Program. “However, pool users should be aware of how to prevent infections while swimming. Remember, chlorine and other disinfectants don’t kill germs instantly. That’s why it’s important for swimmers to protect themselves by not swallowing the water they swim in and to protect others by keeping feces and germs out of the pool by taking a pre-swim shower and not swimming when ill with diarrhea.”

In addition to the precautions listed above, the CDC offers this guidance to the parents of young children:

–Take children on bathroom breaks every 60 minutes or check diapers every 30–60 minutes.
–Change diapers in the bathroom or diaper-changing area and not at poolside where germs can rinse into the water.

Northeastern Dean of Health Sciences Terry Fulmer says going smoke-free will save student’s lives.

“If you smoke when you’re younger, you’re more likely to be addicted for life,” Fulmer said. “So now is our opportunity to help them not get in a habit that will potentially be fatal.”

Northeastern will use peer pressure and a campus education campaign — as opposed to penalties — to enforce the new policy. There’s a free smoking cessation program for students and most faculty and staff can enroll through their insurance plan. Dean Fulmer says she does expect the ban on smoking to affect admissions.

Here’s more on new smoke-free policy from Northeastern:

The deci­sion to go smoke-​​free dove­tails with Northeastern’s focus on solving global chal­lenges in health. According to the Cen­ters for Dis­ease Con­trol and Pre­ven­tion, some 443,000 people die each year from smoking or expo­sure to second-​​hand smoke. What’s more, tobacco use is the single most pre­ventable cause of dis­ease, dis­ability, and death in the United States.

“This new policy reflects Northeastern’s long-​​standing com­mit­ment to pro­moting a healthy and safe envi­ron­ment,” said Terry Fulmer, dean of the Bouvé Col­lege of Health Sci­ences, in a cam­puswide memo on Monday. Fulmer is co-​​chair of the com­mittee along with John Auer­bach, director of the Insti­tute on Urban Health Research and Dis­tin­guished Pro­fessor of Prac­tice in Bouvé’s Depart­ment of Health Sci­ences. “We look for­ward to updating the campus com­mu­nity in the coming months and working with stu­dents, fac­ulty, and staff as we join the more than 1,100 col­leges and uni­ver­si­ties across the nation—and among the first in the Boston area—that have taken this impor­tant step to pro­mote the health of uni­ver­sity campuses.”

Dr. Richard Aghababian, president of the Massachusetts Medical Society says doctors want more research on how much marijuana to prescribe, and what kind, for which diseases.

“There’s not a lot in progress that I’m aware of. Before we treat it like any other medicine like an antibiotic or cardiac antiarrythmia, we’ve got to have some data,” Aghababian said.

The new state law says doctors can certify up to 10 oz. every 60 days for patients with serious medical conditions.

Yesterday, the state Public Health Council approved final rules for the use of medical marijuana. The AP reports:

The law also allows the state to license up to 35 dispensaries to provide marijuana for patients who have been certified by their physicians…

The 52 pages of regulations that were approved unanimously by the state Public Health Council will allow patients approved for medical marijuana to receive up to 10 ounces as a 60-day supply, though some acutely ill patients could receive more with permission from their doctors.

In addition to the medical conditions specified in the law, officials agreed to let doctors use discretion in recommending medical marijuana for other, unspecified conditions that are considered “debilitating” in nature.

“We wanted to make sure that our ballot measure was implemented in a way that allowed folks who needed it to get the marijuana, but was very clear that folks who didn’t need it, shouldn’t,” said Dr. Lauren Smith, interim commissioner of the Department of Public Health…

The regulations call for operators of marijuana dispensaries to test for contaminants including pesticides, mold and mildew, to ensure safety of the drug. The testing must be done by independent, third-party labs with no financial connection to the dispensary, and lab technicians would be given special permission to legally possess marijuana at their facilities.

Patients registered under the medical marijuana program would obtain their 60-day supply of the drug from one of the licensed, nonprofit treatment centers, but the rules also allow — in narrow hardship cases — for patients to cultivate the drug at their home if circumstances prevent them from getting marijuana from a treatment center…

Children under 18 who have conditions likely to be fatal within two years would be eligible for medical marijuana, a change from an earlier recommendation that defined a “life-limiting” illness as six months. Also added was an override provision in which two physicians could certify a child with a debilitating, though not necessarily terminal, condition for medical marijuana.

Still, with the rules set to take effect May 24, the Mass. Medical Society issued a statement raising several concerns:

1. Confidentiality of Information
We support the intent of the DPH to keep patient specific information confidential but are concerned that treating information on physicians as a public record may lead to patients engaging in ‘doctor shopping’ for the drug or to other undesirable results. We suggest that the DPH in practice keep as much information as possible on physician participation available only to the Board of Registration in Medicine or to other investigative agencies.

2. Certifying Authority
The approved regulations contain a provision that opens a legal door to allow the state board of nursing to allow nurse practitioners to certify patients. This is contrary to the literal language of the law approved by the citizens of the Commonwealth and appears inconsistent with the specific language of the regulations regarding the seriousness of the debilitating conditions required for physician certification that a patient may benefit from marijuana. If patients are suffering from the diseases listed in the referendum, it is important that these patients be managed by experienced medical teams led by physicians who are knowledgeable in the management of these conditions.

3. Use by Children
We are concerned that the Department has changed the regulations related to children, by allowing the override of the “life-limiting” provision and by changing the definition of “life-limiting illness” from six months to two years. In the absence of well-designed scientific research data, we are concerned about extending the time from six months to two years. The scientific evidence is clear that marijuana use by children is dangerous, as studies have found toxic effects on the still-developing brains of young people.

Girls need to move for so many reasons, among them, mental clarity, physical fitness and confidence, and simply to learn that their own bodies can bring them immense joy. Now, add another benefit to the list: it keeps them out of trouble.

Researchers from Columbia University in New York report that teenage girls from inner-city neighborhoods who exercised regularly were less likely to carry a gun and engage in violent behavior and activities.

Here are some of the findings, from the Columbia news release:

–Females who exercised more than 10 days in the last month had decreased odds of being in a gang.
–Those who did more than 20 sit-ups in the past four weeks had decreased odds of carrying a weapon or being in a gang.
–Females reporting running more than 20 minutes the last time they ran had decreased odds of carrying a weapon.
–Those who participated in team sports in the past year had decreased odds of carrying a weapon, being in a fight or being in a gang.
–In males, none of the measures of exercise was associated with a decrease in violence-related behaviors, which could be because a larger proportion of males than females did not answer all of the survey questions…

The survey included questions on how often students exercised, how many sit-ups they did and the time of their longest run in the past four weeks as well as whether they played on an organized sports team in the past year.

Students also were asked if they had carried a weapon in the past 30 days or if they were in a physical fight or in a gang in the past year.

Nearly three-quarters of the respondents were Latino, and 19 percent were black. Fifty-six percent were female.

The findings — based on analyzing data from a 2008 survey completed by 1,312 students at four inner-city high schools in New York — were to be presented this week at the Pediatric Academic Societies annual meeting in Washington, DC.

Readers, do you have any experience with teenage girls and exercise and how they may have been influenced by daily activity? Please let us know.

The report, which began as a study on children’s playground injuries, looked at data gathered from Colorado trauma centers in which 6,920 youths were treated between 2000 and 2008, according to CNN:

Of those, 129 had injuries from firearms, and those injuries were extremely serious compared with the others.
Of the gun injuries, 50.4% required intensive care, compared with 19.3% for other trauma-related injuries. Some 13.2% died, compared with the 1.7% injured in another way. A total of 14% of the gunshot wounds were coded as “self-inflicted.”

Here’s more background from the CNN report:

Dr. Angela Sauaia and her colleagues intended to study the impact modernized playground equipment had on lowering children’s injury rates. They ended up studying kids’ injury rates from guns instead.

The associate professor of public health, medicine and surgery at the University of Colorado’s Anschutz Medical Campus in Aurora said she was neither motivated by the recent mass shooting in her area nor driven by politics.

“My colleagues and I were doing a study on playground injuries, because they were doing some remodeling projects here, and we wanted to see if that would change the playground injury rate,” Sauaia said.

“When we started coding the trauma data, which includes all types of childhood injuries that turn up at these trauma centers, and we noticed the morbid pattern of gun violence-related injuries for children … that shifted the focus of the study to document violence related to injuries involving gunshots.”

The data, she said, showed a surprising number of children were being injured, many of them seriously, by guns.

“We had the impression that mass shootings caused so many injuries and those normally do get a lot of national attention, but in looking at the numbers, gun violence was happening to children on a routine basis, and it was mostly happening out of the spotlight,” Sauaia said. “These are not isolated tragedies.”

She and her colleagues knew they were on to something, putting together a research letter called “Firearm Injuries of Children and Adolescents in 2 Colorado Trauma Centers: 2000-2008,” which was published Tuesday in the Journal of the American Medical Association.

The data covers some of the years between the two mass shootings in the Denver area — the 1999 one at Columbine High School that resulted in 13 deaths and more than 20 injuries before the shooters took their own lives, and July’s mass shooting at a movie theater in Aurora that killed 12 people and wounded 58.

“In the years we studied, we didn’t expect to see this many childhood injuries due to everyday gun violence,” Sauaia said. “And far too many of these were self-inflicted.”